The role of cerclage in subsequent pregnancy following previable prelabor rupture of membranes.

Objective To ascertain the outcomes associated with a cervical cerclage among individuals with a history of previable prelabor rupture of membranes (PROM). Study Design A retrospective cohort study conducted at a single tertiary center between 2011 and 2021. We included individuals with a history of previable (before 24 weeks) PROM and the subsequent viable pregnancy. People with multifetal gestation, preterm birth (PTB) or cerclage in previous gestation, or abdominal cerclage after trachelectomy were excluded. Primary outcome was PTB rate (delivery <37 weeks). Recurrence of preterm PROM and composite maternal and neonatal adverse outcomes were evaluated as secondary outcomes. Composite maternal outcome included any of the following: suspected chorioamnionitis, endometritis, red blood cell transfusion, uterine rupture, unplanned hysterectomy, or death. Composite neonatal outcome included any of the following: previable PTB (<24 weeks of gestation), bronchopulmonary dysplasia, grade 3 or 4 intraventricular hemorrhage, necrotizing enterocolitis, mechanical ventilation, seizures, hypoxic ischemic encephalopathy, or death. Results During the study period, 118 individuals had a history of previable PROM and a documented subsequent pregnancy, out of which 74 (62.7%) met inclusion criteria. Nineteen (25.7%) of eligible individuals underwent a cerclage for prior previable PROM and were compared to controls (n=55, 74.3%). People who underwent a cerclage had higher rates of PTB < 37 weeks [63.2% vs 10.9%, p<0.001; OR 14.00, 95% CI 3.97-49.35] and < 34 weeks [21.1% vs 3.6%, p=0.03; OR 7.07, 95% CI 1.18-42.39] compared to those without cerclage. Furthermore, recurrent preterm PROM and previable PTB rates were higher among patients who underwent cerclage. The survival curve further indicated that individuals with cerclage delivered earlier. Composite maternal and neonatal outcome rates were similar in those with and without cerclage. Conclusion Cerclage placement in individuals with prior previable PROM was associated with higher rates of recurrent preterm PROM and PTB.